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Parikh R, Farber HW. Response to "Derivation and validation of a noninvasive prediction tool to identify pulmonary hypertension in patients with IPF: Evolution of the model FORD" by Nathan et al. J Heart Lung Transplant 2024; 43:691-692. [PMID: 38158103 DOI: 10.1016/j.healun.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024] Open
Affiliation(s)
- R Parikh
- Division of Pulmonary, Critical Care and Sleep Medicine, Hartford Hospital, Hartford, Connecticut.
| | - H W Farber
- Division of Pulmonary, Sleep and Critical Care Medicine, Tufts Medical Center, Boston, Massachusetts
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TAN T, Parikh R, Mahapatra A, Perkins R, Go A. WCN23-0469 IgA NEPHROPATHY AND RISKS OF KIDNEY AND CARDIOVASCULAR EVENTS AND DEATH: THE KNIGHT STUDY. Kidney Int Rep 2023. [DOI: 10.1016/j.ekir.2023.02.614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
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3
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Parikh R, Widenmaier R, Weller R, Lecrenier N. An update on national recommendations for the use of the adjuvanted recombinant zoster vaccine. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The adjuvanted recombinant zoster vaccine (RZV), first approved in 2017, has high, long-lasting efficacy against herpes zoster (HZ) and a clinically acceptable safety profile. In addition to the prevention of HZ in adults aged ≥50 years, the non-live RZV can be used from age 18 years in individuals with immunocompromised (IC) conditions. We reviewed the evolving landscape of national recommendations for RZV use.
Methods
National health authority and vaccination committee websites of countries where RZV is approved were searched in March 2022.
Results
Of 41 countries where RZV is licensed, 14 (Australia, Austria, Canada, Czech Republic, Germany, Ireland, Italy, Netherlands, New Zealand, Saudi Arabia, Spain, Switzerland, UK, US) provide national recommendations related to RZV; the majority are preferential to RZV or only recommend RZV. Overall, seven and seven countries recommend immunisation from age 50 years or 60/65 years, respectively. Of the seven countries that recommend immunisation from age 60/65 years, five recommend immunisation in individuals from age 50 years with comorbidities/IC conditions. Five countries recommend immunisation from age 18/19 years in individuals at increased risk of HZ due to immunosuppressive disease/treatment. In addition, six national recommendations refer to RZV safety and nine address prior HZ vaccination and/or infection. All recommendations outlined the RZV administration schedule.
Conclusions
Although national recommendations can inform decision making in clinical practice, RZV recommendations are not available in all licensed countries. The recommendations highlight a trend in favour of the use of RZV for the prevention of HZ in older individuals and those with IC conditions.
Main messages: An increasing number of countries are providing recommendations for the use of RZV for the prevention of HZ in older individuals and those with IC conditions.
Key messages
• An increasing number of countries are providing recommendations for the use of RZV for the prevention of HZ in older individuals.
• An increasing number of countries are providing recommendations for the use of RZV for the prevention of HZ in IC conditions.
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Affiliation(s)
- R Parikh
- Global Medical Affairs , GlaxoSmithKline, Wavre, Belgium
| | - R Widenmaier
- Global Medical Affairs , GlaxoSmithKline, Rockville, USA
| | - R Weller
- Global Medical Affairs , GlaxoSmithKline, Munich, Germany
| | - N Lecrenier
- Global Medical Affairs , GlaxoSmithKline, Wavre, Belgium
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Lecrenier N, Parikh R, Wang C, Curran D, Widenmaier R. The impact of the COVID-19 pandemic on the incidence of herpes zoster. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
There have been several case reports of herpes zoster (HZ) following COVID-19 disease and vaccination. We conducted a non-systematic literature search to elucidate the global effects of the COVID-19 pandemic on the incidence of HZ.
Methods
The literature search was performed in October 2021 using PubMed and Embase. The search string was herpes zoster AND COVID-19. Publications were manually reviewed; case reports were removed.
Results
Three retrospective studies reported the risk of HZ following COVID-19 disease. One study (Bhavsar, 2021) used two US databases and found higher risk of HZ following COVID-19 disease (relative risk [RR]=1.15) and COVID-19 hospitalisation (RR = 1.21), respectively. A strong association between HZ and COVID-19 disease (RR = 5.27) was also reported in a study of the University of Florida patient registry (Katz, 2021). The third study (Barda, 2021) reported no association between COVID-19 disease and risk of HZ (RR = 0.82). In two of the three observational studies in Israel (Furer, 2021 and Barda, 2021), the incidence of HZ was increased following COVID-19 vaccination. The third study (Shasha, 2021) found no association (RR = 1.07). Other studies included a report in Brazil (Maia, 2021) that demonstrated a 35% increase in HZ diagnoses during the pandemic versus pre-pandemic and a published model (La, 2021) that estimated the declining uptake of recombinant zoster vaccine in the US may result in 63,117 avoidable HZ cases in those who remain unvaccinated in 2021.
Conclusions
Emerging data suggest that the COVID-19 pandemic may have increased the risk of HZ and negatively impacted HZ vaccine uptake. Therefore, there is an important need to increase awareness of HZ and HZ vaccination during the pandemic.
Key messages
• There is a need to increase awareness of HZ and HZ vaccination during the COVID-19 era.
• Further studies are needed to fully understand the impact of COVID-19 on the risk of HZ.
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Affiliation(s)
- N Lecrenier
- Global Medical Affairs , GlaxoSmithKline, Wavre, Belgium
| | - R Parikh
- Global Medical Affairs , GlaxoSmithKline, Wavre, Belgium
| | - C Wang
- Epidemiology, GlaxoSmithKline , Rockville, USA
| | - D Curran
- Value Evidence , GlaxoSmithKline, Wavre, Belgium
| | - R Widenmaier
- Global Medical Affairs , GlaxoSmithKline, Rockville, USA
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Parikh R, Konstantinidis I, O'Sullivan DM, Farber HW. Pulmonary Hypertension in patients with Interstitial Lung Disease: a tool for early detection. Pulm Circ 2022; 12:e12141. [PMID: 36225536 PMCID: PMC9531548 DOI: 10.1002/pul2.12141] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/25/2022] [Accepted: 09/16/2022] [Indexed: 11/24/2022] Open
Abstract
Pulmonary hypertension (PH) complicates the treatment of interstitial lung disease (ILD) patients resulting in poor functional status and worse outcomes. Early recognition of PH in ILD is important for initiating therapy and considering lung transplantation. However, no standard exists regarding which patients to screen for PH‐ILD or the optimal method to do so. The aim of this study was to create a risk assessment tool that could reliably predict PH in ILD patients. We developed a PH‐ILD Detection tool that incorporated history, exam, 6‐min walk distance, diffusion capacity for carbon monoxide, chest imaging, and cardiac biomarkers to create an eight‐component score. This tool was analyzed retrospectively in 154 ILD patients where each patient was given a score ranging from 0 to 12. The sensitivity (SN) and specificity (SP) of the PH‐ILD Detection tool and an area‐under‐the‐curve (AUC) were calculated. In this cohort, 74 patients (48.1%) had PH‐ILD. A score of ≥6 on the PH‐ILD Detection tool was associated with a diagnosis of PH‐ILD (SN: 86.5%; SP: 86.3%; area‐under‐the‐curve: 0.920, p < 0.001). The PH‐ILD Detection tool provides high SN and SP for detecting PH in ILD patients. With confirmation in larger cohorts, this tool could improve the diagnosis of PH in ILD and may suggest further testing with right heart catheterization and earlier intervention with inhaled treprostinil and/or lung transplant evaluation.
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Affiliation(s)
- R Parikh
- Division of Pulmonary, Critical Care and Sleep Hartford Hospital Hartford CT
| | - I Konstantinidis
- Department of Internal Medicine University of Connecticut Farmington CT
| | - DM O'Sullivan
- Department of Research Administration Hartford HealthCare Hartford CT
| | - HW Farber
- Division of Pulmonary, Sleep and Critical Care Medicine Tufts Medical Center Boston MA
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Parikh R, Shamimi-Noori S, Reddy S, Gade T, Nadolski G, Hunt S. Abstract No. 284 Demographic trends in female interventional radiology trainees with the advent of the integrated interventional radiology residency: a 12-month update. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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7
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Parra E, Adriani M, Freitas Pinto Lima C, Li J, Haymaker C, Parikh R, Bernicker E, Davar D, Chaudhry A, Stevenson A, Badham C, Fyvie G, Chisamore M, Pant S. 1024P Baseline biomarkers associated with clinical benefit in patients with solid tumors refractory to immune checkpoint inhibitors (ICIs) treated with live biotherapeutic MRx0518 in combination with pembrolizumab. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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8
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Jones N, Francis J, Parikh R, Shaath M. 102 Peer Teaching in Hip Fracture: Responding to the Medical Needs of Surgical Patients and Educational Needs of Junior Doctors. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Fractured Neck of Femur (FNOF) patients are complex. A mortality project identified topics for a peer-led teaching programme.
Method
Eight bite-sized case-based sessions were devised, to provide a framework to approach the following topics: Anaemia, delirium/dementia, ECG abnormalities, metastatic cancer, osteoporosis, renal disease, respiratory disease, and vascular complications. Attendees were asked to complete pre- and post- teaching programme questionnaires using a Likert Scale to indicate agreement with statements relating to the topic areas chosen (1=strongly disagree and 5=strongly agree).
Result
Pre-programme questionnaire: respondents were neutral (average 3.04) when asked whether topic areas were currently “well managed”. Attendees lacked confidence, indicating preparedness as neutral (average 3.35). Trainees agreed that they would benefit from teaching (average 4.56).
Post-programme questionnaire: increased confidence was reported when considering preparedness (average 4.3). Attendees felt the teaching programme was “accessible” and the “topics well-chosen”. 100% of attendees regarded the teaching as ‘excellent’ or ‘very-good’.
Conclusions
Matching patient needs to an educational programme is important.
The “bite-sized” nature of the programme paired with case-based learning increased confidence. A peer-led teaching programme is a positive response to themes emerging from morbidity and mortality reviews.
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Affiliation(s)
- N Jones
- Royal Oldham Hospital, Northern Care Alliance, Manchester, United Kingdom
| | - J Francis
- Royal Oldham Hospital, Northern Care Alliance, Manchester, United Kingdom
| | - R Parikh
- Royal Oldham Hospital, Northern Care Alliance, Manchester, United Kingdom
| | - M Shaath
- Royal Oldham Hospital, Northern Care Alliance, Manchester, United Kingdom
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9
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Parikh R, Dagli M. Abstract No. 517 Virtual follow-up of percutaneous drains placed in interventional radiology during the COVID-19 pandemic. J Vasc Interv Radiol 2021. [PMCID: PMC8079617 DOI: 10.1016/j.jvir.2021.03.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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10
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Abstract
OBJECTIVES The aim of this study was to identify the degree of awareness of the current guidelines and common practices for pleural drain insertion. METHODS A 10-item questionnaire was sent electronically to junior physicians from 4 different hospitals in the South Eastern Sydney and Illawarra Shoalhaven Local Health District. Participants were asked to give their level of experience and management practices for chest drain insertion. RESULTS A total of 94 junior medical officers from 4 hospitals in the district completed the survey. More than 20% had never inserted a chest drain at the time; 72% had primarily learned from bedside teaching and peer learning, but 11% had no training at all. More than 50% of physicians felt that the biggest threat to the procedure was their own lack of confidence for drain insertion. Despite current guidelines, 25% insert chest drains routinely without the aid of ultrasound. A third of interviewees were aware of local guidelines but had not read them. Most physicians (86%) believe that formal standardized training should be available for junior physicians. CONCLUSIONS Our findings demonstrate the ongoing need for improved procedural training in chest drain insertion, with emphasis on mandatory thoracic ultrasound. We consider it important to continue to raise concern and awareness that chest drain insertion is not a harmless procedure, and further physician procedural competence is required.
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Affiliation(s)
| | - Mathew Doyle
- From the Cardiothoracic Surgical Unit, St George Hospital, Kogarah
| | - Roneil Parikh
- From the Cardiothoracic Surgical Unit, St George Hospital, Kogarah
| | - Con Manganas
- From the Cardiothoracic Surgical Unit, St George Hospital, Kogarah
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11
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Bhatia K, Columb M, Bewlay A, Eccles J, Hulgur M, Jayan N, Lie J, Verma D, Parikh R. The effect of COVID-19 on general anaesthesia rates for caesarean section. A cross-sectional analysis of six hospitals in the north-west of England. Anaesthesia 2020; 76:312-319. [PMID: 33073371 DOI: 10.1111/anae.15313] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2020] [Indexed: 12/16/2022]
Abstract
At the onset of the global pandemic of COVID-19 (SARS-CoV-2), guidelines recommended using regional anaesthesia for caesarean section in preference to general anaesthesia. National figures from the UK suggest that 8.75% of over 170,000 caesarean sections are performed under general anaesthetic. We explored whether general anaesthesia rates for caesarean section changed during the peak of the pandemic across six maternity units in the north-west of England. We analysed anaesthetic information for 2480 caesarean sections across six maternity units from 1 April to 1 July 2020 (during the pandemic) and compared this information with data from 2555 caesarean sections performed at the same hospitals over a similar period in 2019. Primary outcome was change in general anaesthesia rate for caesarean section. Secondary outcomes included overall caesarean section rates, obstetric indications for caesarean section and regional to general anaesthesia conversion rates. A significant reduction (7.7 to 3.7%, p < 0.0001) in general anaesthetic rates, risk ratio (95%CI) 0.50 (0.39-0.93), was noted across hospitals during the pandemic. Regional to general anaesthesia conversion rates reduced (1.7 to 0.8%, p = 0.012), risk ratio (95%CI) 0.50 (0.29-0.86). Obstetric indications for caesarean sections did not change (p = 0.17) while the overall caesarean section rate increased (28.3 to 29.7%), risk ratio (95%CI) 1.02 (1.00-1.04), p = 0.052. Our analysis shows that general anaesthesia rates for caesarean section declined during the peak of the pandemic. Anaesthetic decision-making, recommendations from anaesthetic guidelines and presence of an on-site anaesthetic consultant in the delivery suite seem to be the key factors that influenced this decline.
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Affiliation(s)
- K Bhatia
- Department of Anaesthesia and Peri-operative Medicine, University of Manchester, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - M Columb
- Department of Anaesthesia, Peri-operative and Intensive Care Medicine, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - A Bewlay
- Department of Anaesthesia, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - J Eccles
- Department of Anaesthesia, Royal Oldham Hospital, Oldham Care Organisation, Northern Care Alliance NHS Group, Oldham, UK
| | - M Hulgur
- Department of Anaesthesia, Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh NHS Hospital NHS Foundation Trust, Wigan, UK
| | - N Jayan
- Department of Anaesthesia, Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh NHS Hospital NHS Foundation Trust, Wigan, UK
| | - J Lie
- Department of Anaesthesia, Burnley General Teaching Hospital, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - D Verma
- Department of Anaesthesia, Liverpool Women's Hospital, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - R Parikh
- Department of Anaesthesia, Liverpool Women's Hospital, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
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12
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Fleming C, Parikh R, Faruqi A, Contrera K, Xiong D, Rybicki L, Woody N, Joshi N, Greskovich J, Chute D, Ku J, Prendes B, Lamarre E, Lorenz R, Scharpf J, Burkey B, Schwartzman L, Geiger J, Adelstein D, Koyfman S. A Comparison Of Prognostic Factors For Survival After Distant Metastasis In HPV+ And HPV- Head And Neck Cancers. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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13
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Ganatra S, Abraham S, Parikh R, Kamenetsky D, Patel R, Dani S, Chaudhry G, Resnic F, Shah S, Venesy D, Patten R, Neilan T, Reynolds M, Hook B, Nohria A. Efficacy and safety of catheter ablation for atrial fibrillation in patients with cancer. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) is the most common arrhythmia in patients with cancer. Management of AF in patients with cancer poses unique challenges. Long-term use of antiarrhythmic drug (AAD) therapy lacks evidence of efficacy in this population and poses risk of drug interactions. Catheter ablation is a well-established treatment modality for AAD resistant symptomatic AF and in patients with heart failure. Nevertheless, the effectiveness and safety of catheter ablation in patients with cancer is not well established.
Method
We retrospectively analyzed consecutive patients who underwent catheter ablation for AF, with either history of cancer (other than non-melanoma skin cancer) within 5-years prior or exposure to systemic anthracycline and/or thoracic radiation therapy at any time.
Results
The study included 162 patients. The mean age was 65.5 (26–84 years) years and 50% were female. Overall 133 (82%) patients had freedom from AF at 12 months following ablation. Of these 74 (54%) required post-ablation AAD, 18 (13.5%) required another ablation within the first 12 months and 9 (6.7%) required both AAD and a second ablation to maintain sinus rhythm. There were 14 adverse events (8.6%); 5 access site and 4 non-access site bleeding, 2 strokes, 2 cardiac tamponade and 1 pulmonary vein stenosis with ≈1% serious complications.
Conclusion
The success of catheter ablation for AF and the incidence of procedure related complications in patients with a history of recent cancer or prior exposure to cardiotoxic therapies are similar to that reported in patients without a history of cancer and hence if needed, it should be considered in select patients.
Funding Acknowledgement
Type of funding source: Private hospital(s). Main funding source(s): Dr. S Ganatra is supported by Lahey Physician Research Stipend Program.
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Affiliation(s)
- S Ganatra
- Lahey Hospital & Medical Center, Burlington, United States of America
| | - S Abraham
- Lahey Hospital & Medical Center, Burlington, United States of America
| | - R Parikh
- Lahey Hospital & Medical Center, Burlington, United States of America
| | - D Kamenetsky
- Lahey Hospital & Medical Center, Burlington, United States of America
| | - R Patel
- Lahey Hospital & Medical Center, Burlington, United States of America
| | - S Dani
- Lahey Hospital & Medical Center, Burlington, United States of America
| | - G Chaudhry
- Lahey Hospital & Medical Center, Burlington, United States of America
| | - F Resnic
- Lahey Hospital & Medical Center, Burlington, United States of America
| | - S Shah
- Lahey Hospital & Medical Center, Burlington, United States of America
| | - D Venesy
- Lahey Hospital & Medical Center, Burlington, United States of America
| | - R Patten
- Lahey Hospital & Medical Center, Burlington, United States of America
| | - T Neilan
- Massachusetts General Hospital - Harvard Medical School, Boston, United States of America
| | - M Reynolds
- Lahey Hospital & Medical Center, Burlington, United States of America
| | - B Hook
- Lahey Hospital & Medical Center, Burlington, United States of America
| | - A Nohria
- Brigham and Women'S Hospital, Harvard Medical School, Boston, United States of America
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14
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Ganatra S, Redd R, Hayek S, Parikh R, Azam T, Yanik G, Spendley L, Nikiforow S, Jacobson C, Nohria A. Cardiovascular effects of chimeric antigen receptor t-cell therapy for refractory or relapsed non-hodgkin lymphoma. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Purpose
Cardiovascular complications of chimeric antigen receptor T-cell (CAR T-cell) therapy are poorly understood. We examined the incidence, predictors and impact of new or worsening cardiomyopathy in patients undergoing CAR T-cell therapy.
Methods
All patients with refractory or relapsed non-Hodgkin's lymphoma, undergoing CAR T-cell therapy at collaborative institutes underwent serial echocardiograms at baseline and within 7 days after developing high-grade cytokine release syndrome (CRS), and were followed for all-cause mortality. New or worsening cardiomyopathy was defined as a reduction in left ventricular ejection fraction (LVEF) >10% from baseline to <50% during the index hospitalization.
Results
Among 187 consecutive CAR T-cell therapy patients, 116 (50 Grade ≤1 CRS, 66 Grade ≥2 CRS) had >1 echocardiogram performed and were included in this analysis. The median age was 63 (range 19–80) years, 42% were women, 91% were Caucasian. A total of 12 (10.3%) patients developed new or worsening cardiomyopathy with a decline in LVEF from 58±6% to 36±7% within a median of 12.5 (range 2–24) days of CAR T-cell infusion. In multivariable analyses, older age, prior stem cell transplantation, baseline angiotensin-converting enzyme inhibitor use and CRS grade ≥2 were associated with the development of cardiomyopathy. Patients who developed cardiomyopathy were more likely to require vasopressor support (p=0.004) and mechanical ventilation (p=0.014). LVEF improved in 9/12 (75%) patients. CAR T-cell associated cardiomyopathy did not impact overall mortality or cancer response to CAR-T cell therapy.
Conclusions
Patients undergoing CAR T-cell therapy are at risk of developing cardiomyopathy and hemodynamic instability. Pre-CAR T-cell therapy cardiovascular risk stratification and echocardiogram surveillance during therapy should be considered for prompt identification and mitigation of cardiac complications.
Predictors of Cardiomyopathy Development
Funding Acknowledgement
Type of funding source: Private hospital(s). Main funding source(s): Anju Nohria, MD is supported by the Gelb Master Clinician Award at Brigham and Women's Hospital.
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Affiliation(s)
- S Ganatra
- Lahey Hospital and Medical Center, Burlington, United States of America
| | - R Redd
- Dana Farber Cancer Institute, Boston, United States of America
| | - S Hayek
- University of Michigan, Ann Arbor, United States of America
| | - R Parikh
- Lahey Hospital and Medical Center, Burlington, United States of America
| | - T Azam
- University of Michigan, Ann Arbor, United States of America
| | - G Yanik
- University of Michigan, Ann Arbor, United States of America
| | - L Spendley
- Dana Farber Cancer Institute, Boston, United States of America
| | - S Nikiforow
- Dana Farber Cancer Institute, Boston, United States of America
| | - C Jacobson
- Dana Farber Cancer Institute, Boston, United States of America
| | - A Nohria
- Dana Farber Cancer Institute, Boston, United States of America
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15
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Karpes JB, Lansom JD, Alshahrani M, Parikh R, Shamavonian R, Alzahrani NA, Liauw W, Morris DL. Repeat cytoreductive surgery with or without intraperitoneal chemotherapy for recurrent epithelial appendiceal neoplasms. BJS Open 2020; 4:478-485. [PMID: 32020757 PMCID: PMC7260401 DOI: 10.1002/bjs5.50262] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/19/2019] [Indexed: 12/30/2022] Open
Abstract
Background With recurrence rates after primary cytoreductive surgery (CRS) in excess of 50 per cent, repeat CRS is being performed increasingly, but survival outcomes have not been reported widely. This study examined the outcomes following repeat CRS for appendiceal cancer with peritoneal surface malignancy (PSM), and evaluated its feasibility and safety. Methods A retrospective cohort of patients who had surgery between 1996 and 2018 were analysed. Patients who underwent a single CRS procedure with or without heated intraperitoneal chemotherapy (HIPEC) were compared with those who had multiple procedures with or without HIPEC. Perioperative morbidity and survival outcomes were analysed. Results Some 462 patients were reviewed, 102 of whom had repeat procedures. For high‐grade tumours, patients who had a single CRS procedure had significantly reduced overall survival (OS) compared with those who had repeat CRS (55·6 versus 90·7 months respectively; P = 0·016). For low‐grade tumours, there was no difference in OS (P = 0·153). When patients who had a single procedure were compared with those who had multiple procedures, there was no significant difference in major morbidity (P = 0·441) or in‐hospital mortality (P = 0·080). For multiple procedures, no differences were found in major morbidity (P = 0·262) or in‐hospital mortality (P = 0·502) when the first procedure was compared with the second. For low‐grade cancers, the peritoneal carcinomatosis index was a significant prognostic factor for OS (hazard ratio (HR) 1·11, 95 per cent c.i. 1·05 to 1·17; P < 0·001), whereas for high‐grade cancers repeat CRS (HR 0·57, 0·33 to 0·95; P = 0·033), complete cytoreduction score (HR 1·55, 1·01 to 2·40; P = 0·046) and presence of signet ring cells (HR 2·77, 1·78 to 4·30; P < 0·001) were all significant indicators of long‐term survival. Conclusion In selected patients presenting with PSM from epithelial appendiceal neoplasms, repeat CRS performed in high‐volume centres could provide survival benefits.
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Affiliation(s)
- J B Karpes
- Liver and Peritonectomy Unit, St George Hospital, Sydney, New South Wales, Australia.,St George and Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - J D Lansom
- Liver and Peritonectomy Unit, St George Hospital, Sydney, New South Wales, Australia
| | - M Alshahrani
- Liver and Peritonectomy Unit, St George Hospital, Sydney, New South Wales, Australia
| | - R Parikh
- Liver and Peritonectomy Unit, St George Hospital, Sydney, New South Wales, Australia
| | - R Shamavonian
- Liver and Peritonectomy Unit, St George Hospital, Sydney, New South Wales, Australia.,St George and Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - N A Alzahrani
- Liver and Peritonectomy Unit, St George Hospital, Sydney, New South Wales, Australia.,College of Medicine, Al Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - W Liauw
- Liver and Peritonectomy Unit, St George Hospital, Sydney, New South Wales, Australia.,Cancer Care Clinic, St George Hospital, Sydney, New South Wales, Australia
| | - D L Morris
- Liver and Peritonectomy Unit, St George Hospital, Sydney, New South Wales, Australia.,St George and Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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Parikh R, Michelson D, Sapru M, Sahu R, Singh A, Cuijpers P, Patel V. Priorities and preferences for school-based mental health services in India: a multi-stakeholder study with adolescents, parents, school staff, and mental health providers. Glob Ment Health (Camb) 2019; 6:e18. [PMID: 31531228 PMCID: PMC6737585 DOI: 10.1017/gmh.2019.16] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/31/2019] [Accepted: 07/10/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Schools are important settings for increasing reach and uptake of adolescent mental health interventions. There is limited consensus on the focus and content of school-based mental health services (SBMHSs), particularly in low-resource settings. This study elicited the views of diverse stakeholders in two urban settings in India about their priorities and preferences for SBMHSs. METHODS We completed semi-structured interviews and focus group discussions with adolescents (n = 191), parents (n = 9), teachers (n = 78), school counsellors (n = 15), clinical psychologists/psychiatrists (n = 7) in two urban sites in India (Delhi and Goa). Qualitative data were obtained on prioritized outcomes, preferred content and delivery methods, and indicated barriers. RESULTS All stakeholders indicated the need for and acceptability of SBMHSs. Adolescents prioritized resolution of life problems and exhibited a preference for practical guidance. Parents and teachers emphasized functional outcomes and preferred to be involved in interventions. In contrast, adolescents' favored limited involvement from parents and teachers, was related to widespread concerns about confidentiality. Face-to-face counselling was deemed to be the most acceptable delivery format; self-help was less frequently endorsed but was relatively more acceptable if blended with guidance or delivered using digital technology. Structured sensitization was recommended to promote adolescent's engagement. Providers endorsed a stepped care approach to address different levels of mental health need among adolescents. CONCLUSION SBMHSs are desired by adolescents and adult stakeholders in this setting where few such services exist. Sensitization activities are required to support implementation. School counsellors have an important role in identifying and treating adolescents with different levels of mental health needs, and a suite of interventions is needed to target these needs effectively and efficiently.
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Affiliation(s)
- R. Parikh
- Sangath, C-1/52, 1st Floor, Safdarjung Development Area, New Delhi, Delhi, India
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, van der Boechorstraat 1, Amsterdam, The Netherlands
| | - D. Michelson
- School of Psychology, University of Sussex, Falmer, Brighton, UK
| | - M. Sapru
- Evalueserve.com Private Limited, Tower 6, 8th Floor, Candor Gurgaon One Realty Projects Pvt. Ltd., IT/ITES SEZ, Candor TechSpace, Tikri, Sector-48, Gurgaon, Haryana, India
| | - R. Sahu
- Sangath, C-1/52, 1st Floor, Safdarjung Development Area, New Delhi, Delhi, India
| | - A. Singh
- International Rescue Committee, No 69/54, Oat Tha Phaya Street, Kyaikkasan Quarter, Bahan Township, Yangon, Myanmar
| | - P. Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, van der Boechorstraat 1, Amsterdam, The Netherlands
| | - V. Patel
- Sangath, C-1/52, 1st Floor, Safdarjung Development Area, New Delhi, Delhi, India
- Department of Global Health and Social Medicine, Harvard Medical School, 641, Huntington Avenue, Boston, MA, USA
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Ludlam S, Khan J, Ganiyu A, Parikh R. 53TEACHING FOUNDATION YEAR TWO (FY2) DOCTORS ABOUT THE GERIATRIC GIANTS: CAN WE IMPROVE CONFIDENCE WITH COMPLEXITY? Age Ageing 2019. [DOI: 10.1093/ageing/afz057.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - J Khan
- The Royal Oldham Hospital
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18
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Warburton T, Rutherford L, Parikh R. 62MEMORIES OF ‘66 AT THE NATIONAL FOOTBALL MUSEUM: REMINISCENCE THERAPY TEACHING FOR REGISTRARS. Age Ageing 2019. [DOI: 10.1093/ageing/afz057.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - R Parikh
- Royal Oldham Hospital
- University of Salford
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Khan J, Ganiyu A, Ludlam S, Parikh R. 55RATIONAL PRESCRIBING: POLYPHARMACY AND OPTIMAL PRESCRIBING TEACHING FOR FOUNDATION YEAR TWO (FY2) DOCTORS. Age Ageing 2019. [DOI: 10.1093/ageing/afz057.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Khan
- The Royal Oldham Hospital
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20
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Nelson RL, Go C, Darwish R, Gao J, Parikh R, Kang C, Mahajan A, Habeeb L, Zalavadiya P, Patnam M. Cesarean delivery to prevent anal incontinence: a systematic review and meta-analysis. Tech Coloproctol 2019; 23:809-820. [PMID: 31273486 DOI: 10.1007/s10151-019-02029-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 06/20/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cesarean delivery (CD), is increasingly recommended as a mode of delivery that prevents the anal incontinence (AI) that arises in some women after vaginal delivery (VD). The assessment of the efficacy of CD in this regard was the subject of this systematic review. METHODS Searches were conducted in Medline, EMBASE and the Cochrane Library. Both randomized (RCTs) and non-randomized trials (NRTs) comparing the risk of sustained fecal and/or flatus incontinence after VD or CD were sought from 1966 to 1 January, 2019. Studies were eligible if they assessed AI more than 6 months after birth, and had statistical adjustment for at least one of the three major confounders for AI: age, maternal weight or parity. In addition, each study was required to contain more than 250 participants, more than 50 CDs and more than 25 cases of AI. Data after screening and selection were abstracted and entered into Revman for meta-analysis. Analyses were done for combined fecal and flatus incontinence (comAI), fecal incontinence (FI), gas incontinence (GI), CD before or during labor, time trend of incontinence after delivery, assessment of both statistical and clinical heterogeneity, parity and late incident AI. RESULTS Out of the 2526 titles and abstracts found, 24 eligible studies were analyzed, 23 NRTs and one RCT. These included women with 29,597 VDs and women with 6821 CDs. Among the primary outcomes, VD was found not to be a significant predictor of postpartum comAI compared to CD in 6 studies, incorporating 18,951 deliveries (OR = 0.74; 0.54-1.02). VD was also not a significant predictor of FI in 14 studies, incorporating 29,367 deliveries, (OR = 0.89; 0.76-1.05). VD was not a significant predictor of GI in six studies, incorporating 6724 deliveries (OR = 0.96; 0.79-1.18). The strength of the grading of recommendations, assessment, development and evaluations (GRADE) evidence for each of these was low for comAI and moderate for FI and GI (upgrade for lack of expected effect). Time trend FI showed incontinence at 3 months often resolved at 1 year. Other secondary analyses assessing parity, delayed incidence of FI, clinical and statistical heterogeneity, spontaneous VD only, late risk of incidence of AI, and CD in or prior to labor all had similar results as in the primary outcomes. CONCLUSIONS There are three components of pelvic floor dysfunction that are thought to be caused by VD and hopefully prevented by CD: AI, urinary incontinence and pelvic floor prolapse. Of these, AI was not found to be reliably prevented by CD in this review.
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Affiliation(s)
- R L Nelson
- Epidemiology/Biometry Division, University of Illinois School of Public Health, Chicago, IL, USA.
| | - C Go
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - R Darwish
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - J Gao
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - R Parikh
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - C Kang
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - A Mahajan
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - L Habeeb
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - P Zalavadiya
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
| | - M Patnam
- Honors College, University of Illinois at Chicago, Chicago, IL, USA
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Karpes J, Parikh R, Shamavonian R, Alzahrani N, Morris DL. Analysis of feasibility and survival in repeated cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) in appendiceal cancer with peritoneal dissemination. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e15702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15702 Background: CRS/HIPEC has been established as the method of choice for the management of peritoneal dissemination from appendiceal cancer. With recurrence rates after first surgery as high as 44%, re-do CRS/HIPEC is evolving as an effective recurrent treatment regime. This analysis examines the feasibility of repeated CRS/HIPEC for patients with appendiceal cancer with peritoneal dissemination and evaluates the survival outcomes. Methods: A retrospective cohort study of 1074 patients who had CRS/HIPEC procedures and had a recorded tumour grade from 1996 to 2017 was performed. Morbidity and mortality as well as the survival effect was analysed. Tumour grade was divided into low grade: diffuse peritoneal adenomucinosis (DPAM); and high grade: peritoneal mucinous carcinomatosis (PMCA). Results: Initial CRS/HIPEC comprised of 991 patients, with 148 of those undergoing repeated CRS/HIPEC for appendiceal cancer with peritoneal dissemination. The overall survival for patients with DPAM who had only one CRS/HIPEC was 248 months with a five-year survival of 80%, compared to an overall survival of 75 months and five-year survival of 54% in those who had repeated CRS/HIPEC. For patients with PMCA, the overall survival of those who only had one CRS/HIPEC was 63 months with a five-year survival of 47%, compared to an overall survival of 52 months and five-year survival of 44% in those who had repeated CRS/HIPEC. There was no statistically significant difference in the morbidity and mortality for patients who had repeated CRS/HIPEC for management of appendiceal cancer with peritoneal metastases when compared to those who only had one. Conclusions: This study suggests that re-do CRS/HIPEC is a feasible and effective treatment regime in the management of tumour recurrence in appendiceal cancer with peritoneal dissemination, with no difference in the morbidity and mortality of patients who had repeated CRS/HIPEC compared to only one procedure.
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22
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Parikh R, Shah S, Dhurandhar V, Alzahrani N, Fisher OM, Arrowaili A, Liauw W, Morris D. An analysis of the morbidity associated with abdominal wall resection and reconstruction after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). Eur J Surg Oncol 2019; 45:394-399. [PMID: 30638806 DOI: 10.1016/j.ejso.2018.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/21/2018] [Accepted: 12/27/2018] [Indexed: 12/11/2022] Open
Abstract
PURPOSE CRS/HIPEC has evolved as an effective method for management of selected patients with peritoneal metastatic disease. Abdominal wall resection (AWR) is often required, and may require complex reconstructions, such as component separation (CST) leading to wound dehiscence (WD) and wound complications (WC). The purpose of our study was to analyse factors contributing to wound complications and wound recurrence (WR). METHODS Retrospective review of a prospective database of 1074 patients undergoing CRS/HIPEC procedures from 1996 to 2017 at St George Hospital. RESULTS AWR and reconstruction for abdominal wall metastases was performed in 197 (18.3%) patients. Tumour types included mesothelioma, appendiceal, colorectal and ovarian cancers. Grade III WC were found in 21 (10.6%). WD was found in 14 (7.1%) compared to 30 (3.4%) in 877 patients without AWR (p = 0.028). Midline WR was seen in 26 (13.3%) with AWR and mean time to recurrence of 18 months. Multivariable' regression analysis showed age (OR 1.06, 95%CI 1.01-1.11, p = 0.022) and CST (OR 9.63, 95%CI 2.55-36.23, p = 0.001) were independent predictors of Grade III WC, and CST (OR 4.19, 95%CI 1.27-13.86, p = 0.019) was an independent predictor of WD after AWR. The presence of a higher prior surgical score (PSS) 2-3 (OR 2.74, 95%CI 1.16-6.49, p = 0.022) was an independent predictor of midline WR post AWR. CONCLUSION This study demonstrates that patients undergoing AWR have a higher incidence of postoperative WD. CST was associated with an increased incidence of Grade III WC and WD. Patients with a higher PSS were more likely to develop midline wound recurrence.
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Affiliation(s)
- Roneil Parikh
- Peritonectomy and Liver Unit, Department of Surgery, St George Hospital, Kogarah, NSW, 2217, Sydney, Australia; St George Hospital Clinical School, University of New South Wales, Chapel Street, Kogarah, NSW, 2217, Sydney, Australia.
| | - Sanjana Shah
- Gosford Hospital, Holden Street, Gosford, NSW, 2250, Sydney, Australia.
| | - Vikrant Dhurandhar
- Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, NSW, 2050, Sydney, Australia.
| | - Nayef Alzahrani
- Peritonectomy and Liver Unit, Department of Surgery, St George Hospital, Kogarah, NSW, 2217, Sydney, Australia; College of Medicine, Al Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia.
| | - Oliver M Fisher
- Peritonectomy and Liver Unit, Department of Surgery, St George Hospital, Kogarah, NSW, 2217, Sydney, Australia.
| | - Arief Arrowaili
- College of Medicine, Al Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia.
| | - Winston Liauw
- Peritonectomy and Liver Unit, Department of Surgery, St George Hospital, Kogarah, NSW, 2217, Sydney, Australia; Cancer Care Centre, St George Hospital, Kogarah, NSW, 2217, Sydney, Australia.
| | - David Morris
- Peritonectomy and Liver Unit, Department of Surgery, St George Hospital, Kogarah, NSW, 2217, Sydney, Australia; St George Hospital Clinical School, University of New South Wales, Chapel Street, Kogarah, NSW, 2217, Sydney, Australia.
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23
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Villanueva C, Doyle M, Parikh R, Manganas C. Patient Safety and Current Practice During Chest Drain Insertion. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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24
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Pickavance E, Oates R, Parikh R. 11REFLECTIVE WRITING: A PEER TEACHING INTERVENTION FOR SPECIALITY REGISTRARS IN GERIATRIC MEDICINE. Age Ageing 2018. [DOI: 10.1093/ageing/afy123.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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25
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Desai MP, Sharma R, Riaz I, Sudhanshu S, Parikh R, Bhatia V. Newborn Screening Guidelines for Congenital Hypothyroidism in India: Recommendations of the Indian Society for Pediatric and Adolescent Endocrinology (ISPAE) - Part I: Screening and Confirmation of Diagnosis. Indian J Pediatr 2018; 85:440-447. [PMID: 29380252 DOI: 10.1007/s12098-017-2575-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 12/13/2017] [Indexed: 12/29/2022]
Abstract
UNLABELLED The Indian Society for Pediatric and Adolescent Endocrinology has formulated locally relevant Clinical Practice Guidelines for newborn screening, diagnosis and management of primary congenital hypothyroidism (CH). RECOMMENDATIONS Screening should be done for every newborn using cord blood, or postnatal blood, ideally at 48 to 72 h of age. On this screen sample, neonates with TSH > 20 mIU/L serum units (or >34 mIU/L for samples taken between 24 to 48 h of age) should be recalled for confirmation. For screen TSH > 40 mIU/L, immediate confirmatory venous T4/FT4 and TSH, and for milder elevation of screen TSH, a second screening TSH at 7 to 10 d of age, should be taken. Preterm and low birth weight infants should undergo screening at 48-72 h postnatal age. Sick babies should be screened at least by 7 d of age. Venous confirmatory TSH >20 mIU/L before age 2 wk and >10 mIU/L after age 2 wk, with low T4 (<10 μg/dL) or FT4 (<1.17 ng/dL) indicate primary CH and treatment initiation. Imaging is recommended by radionuclide scintigraphy and ultrasonography after CH is biochemically confirmed but treatment should not be delayed till scans are performed. Levothyroxine is commenced at 10 to 15 μg/kg in the neonatal period. Serum T4/FT4 is measured at 2 wk and TSH and T4/FT4 at 1 mo, then 2 monthly till 6 mo, 3 monthly from 6 mo-3 y and every 3-6 mo thereafter. Babies with the possibility of transient congenital hypothyroidism should be re-evaluated at age 3 y, to assess the need for lifelong therapy.
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Affiliation(s)
- M P Desai
- Division of Pediatric Endocrinology, Bai Jerbai Wadia Hospital for Children, Institute of Child Health & Research Centre, Parel, Mumbai, India
| | - R Sharma
- Division of Pediatric Endocrinology, Department of Pediatrics, All India Institute of Medical Sciences, Room no. 3058, Teaching Block, New Delhi, 110029, India.
| | - I Riaz
- Department of Pediatrics, SAT Hospital, Government Medical College, Thiruvananthapuram, India
| | - S Sudhanshu
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - R Parikh
- Division of Pediatric Endocrinology, Bai Jerbai Wadia Hospital for Children, Institute of Child Health & Research Centre, Parel, Mumbai, India
| | - V Bhatia
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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26
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Mehta T, Desai N, Mehta K, Parikh R, Male S, Hussain M, Ollenschleger M, Spiegel G, Grande A, Ezzeddine M, Jagadeesan B, Tummala R, McCullough L. Outcomes of early carotid stenting and angioplasty in large-vessel anterior circulation strokes treated with mechanical thrombectomy and intravenous thrombolytics. Interv Neuroradiol 2018; 24:392-397. [PMID: 29697301 DOI: 10.1177/1591019918768574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction Proximal cervical internal carotid artery stenosis greater than 50% merits revascularization to mitigate the risk of stroke recurrence among large-vessel anterior circulation strokes undergoing mechanical thrombectomy. Carotid artery stenting necessitates the use of antiplatelets, and there is a theoretical increased risk of hemorrhagic transformation given that such patients may already have received intravenous thrombolytics and have a significant infarct burden. We investigate the outcomes of large-vessel anterior circulation stroke patients treated with intravenous thrombolytics receiving same-day carotid stenting or selective angioplasty compared to no carotid intervention. Materials and methods The study cohort was obtained from the National (Nationwide) Inpatient Sample database between 2006 and 2014, using International Statistical Classification of Diseases, ninth revision discharge diagnosis and procedure codes. A total of 11,825 patients with large-vessel anterior circulation stroke treated with intravenous thrombolytic and mechanical thrombectomy on the same day were identified. The study population was subdivided into three subgroups: no carotid intervention, same-day carotid angioplasty without carotid stenting, and same-day carotid stenting. Outcomes were assessed with respect to mortality, significant disability at discharge, hemorrhagic transformation, and requirement of percutaneous endoscopic gastronomy tube placement, prolonged mechanical ventilation, or craniotomy. Results This study found no statistically significant difference in patient outcomes in those treated with concurrent carotid stenting compared to no carotid intervention in terms of morbidity or mortality. Conclusions If indicated, it is reasonable to consider concurrent carotid stenting and/or angioplasty for large-vessel anterior circulation stroke patients treated with mechanical thrombectomy who also receive intravenous thrombolytics.
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Affiliation(s)
- T Mehta
- 1 Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - N Desai
- 2 Department of Neurology, Hartford Hospital, Hartford, CT, USA
| | - K Mehta
- 3 Department of Hematology-Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - R Parikh
- 4 Department of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - S Male
- 1 Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - M Hussain
- 5 Department of Interventional Neuroradiology, Hartford Hospital, Hartford, CT, USA
| | - M Ollenschleger
- 5 Department of Interventional Neuroradiology, Hartford Hospital, Hartford, CT, USA
| | - G Spiegel
- 6 Department of Neuroradiology, University of Texas Health Sciences Center, Houston, TX, USA
| | - A Grande
- 7 Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - M Ezzeddine
- 1 Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - B Jagadeesan
- 8 Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - R Tummala
- 7 Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - L McCullough
- 9 Department of Neurology, University of Texas Health Sciences Center, Houston, TX, USA
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John D, Parikh R. Cost-effectiveness of community screening for glaucoma in rural India: a decision analytical model. Public Health 2018; 155:142-151. [DOI: 10.1016/j.puhe.2017.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 10/18/2022]
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Kozman MA, Fisher OM, Rebolledo BAJ, Parikh R, Valle SJ, Arrowaili A, Alzahrani N, Liauw W, Morris DL. CEA to peritoneal carcinomatosis index (PCI) ratio is prognostic in patients with colorectal cancer peritoneal carcinomatosis undergoing cytoreduction surgery and intraperitoneal chemotherapy: A retrospective cohort study. J Surg Oncol 2017; 117:725-736. [PMID: 29266235 DOI: 10.1002/jso.24911] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 10/15/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Serum tumor markers are prognostic in patients with colorectal cancer peritoneal carcinomatosis (CRPC) undergoing cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC). Assessment of the ratio of tumor marker to volume, as depicted by peritoneal carcinomatosis index (PCI), and how this may affect overall (OS) and recurrence free survival (RFS) has not been reported. METHODS Survival effect of this ratio was analyzed in patients with CRPC managed from 1996 to 2016 with CRS and IPC. RESULTS Of 260 patients included, those with low CEA/PCI ratio (<2.3) had longer median OS (56 vs 24 months, P = 0.001) and RFS (13 vs 9 months, P = 0.02). The prognostic impact of CEA/PCI ratio was most pronounced in patients with PCI ≤ 10 (OS of 72 vs 30 months, P < 0.001; RFS of 21 vs 10 months, P = 0.002). In multivariable analysis, elevated CEA/PCI ratio was independently associated with poorer OS (adjusted HR 1.85, 95%CI 1.11-3.10, P = 0.02) and RFS (adjusted HR 1.58, 95%CI 1.04-2.41, P = 0.03). CONCLUSION CEA/PCI ratio is an independent prognostic factor for OS and RFS in CRPC. This novel approach allows both tumor activity and volume to be accounted for in one index, thus potentially providing a more accurate indication of tumor biological behavior.
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Affiliation(s)
- Mathew A Kozman
- Hepatobiliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, Kogarah, NSW, Australia.,St George Hospital Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Oliver M Fisher
- Hepatobiliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, Kogarah, NSW, Australia.,St George Hospital Clinical School, University of New South Wales, Sydney, NSW, Australia.,School of Medicine, University of Notre Dame, Sydney, NSW, Australia
| | - Bree-Anne J Rebolledo
- Hepatobiliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, Kogarah, NSW, Australia
| | - Roneil Parikh
- Hepatobiliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, Kogarah, NSW, Australia
| | - Sarah J Valle
- Hepatobiliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, Kogarah, NSW, Australia
| | - Arief Arrowaili
- College of Medicine, Al-Imam Mohammad Ibn Saud Ismalic University, Riyadh, Saudi Arabia
| | - Nayef Alzahrani
- Hepatobiliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, Kogarah, NSW, Australia.,St George Hospital Clinical School, University of New South Wales, Sydney, NSW, Australia.,College of Medicine, Al-Imam Mohammad Ibn Saud Ismalic University, Riyadh, Saudi Arabia
| | - Winston Liauw
- St George Hospital Clinical School, University of New South Wales, Sydney, NSW, Australia.,Cancer Care Centre, St George Hospital, Kogarah, NSW, Australia
| | - David L Morris
- Hepatobiliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, Kogarah, NSW, Australia.,St George Hospital Clinical School, University of New South Wales, Sydney, NSW, Australia
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Parikh R, Millar E, Phan-Thien KC. A case of amoebic colitis following remote historical exposure. ANZ J Surg 2017; 89:E222-E223. [PMID: 29205764 DOI: 10.1111/ans.14278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 09/18/2017] [Accepted: 09/23/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Roneil Parikh
- St George Hospital Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Ewan Millar
- School of Medical Sciences, The University of New South Wales, Sydney, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.,NSW Health Pathology, Department of Anatomical Pathology, St George Hospital, Sydney, New South Wales, Australia
| | - Kim-Chi Phan-Thien
- St George Hospital Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
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Parikh R, Tsakanov S, Jamnagerwalla M. Retroperitoneal abscess caused by foreign body ingestion. ANZ J Surg 2017; 88:E849-E850. [PMID: 28295879 DOI: 10.1111/ans.13930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 11/06/2016] [Accepted: 01/18/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Roneil Parikh
- Department of General Surgery, Sutherland Hospital, Sydney, New South Wales, Australia
| | - Sergei Tsakanov
- Department of General Surgery, Sutherland Hospital, Sydney, New South Wales, Australia
| | - Murtaza Jamnagerwalla
- Department of General Surgery, Sutherland Hospital, Sydney, New South Wales, Australia
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Sadeghi S, Groshen S, Parikh R, Mortazavi A, Dorff T, Hoimes C, Pal S, Levine E, Doyle L, Quinn D, Newman E, Lara P. Phase II California Cancer Consortium trial of gemcitabine–eribulin combination (GE) in cisplatin ineligible patients (pts) with metastatic urothelial carcinoma (mUC): tolerability and toxicity report (NCI-9653; 1UM1CA186717-01, NO1-CM-2011-00038). Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30706-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Dhurandhar V, Parikh R, Saxena A, Vallely MP, Wilson MK, Black DA, Tran L, Reid CM, Bannon PG. The Aortic Root Replacement Procedure: 12-year Experience from the Australian and New Zealand Society of Cardiac and Thoracic Surgeons Database. Heart Lung Circ 2016; 25:1245-1251. [PMID: 27269475 DOI: 10.1016/j.hlc.2016.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 04/06/2016] [Accepted: 04/10/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aortic root replacement procedure (ARR), is often considered the gold standard in the management of aortic root and ascending aorta aneurysms. Our aim was to review the Australian experience with this procedure to ascertain early and late outcomes of mortality and morbidity. METHODS We reviewed the Australian and New Zealand Society of Cardiac and Thoracic Surgeons' (ANZSCTS) database for patients undergoing ARR. Preoperative, intraoperative and postoperative variables were analysed. Multiple regression was performed to determine independent predictors of 30-day mortality and permanent stroke, and predictors of late death. Survival estimates were obtained by cross-linking the ANZSCTS database with the Australian Institute of Health and Welfare's National Death Index database. RESULTS Between January 2001 and December 2011, 954 patients underwent ARR with a mean age of 56±15.2 years. The overall 30-day mortality was 5.9% (n=56) with a permanent stroke rate of 2.3% (n=21). The elective surgery mortality was 3.6%. Long-term survival was estimated as 84.4% and 68.7% at 5 and 10 years, respectively. CONCLUSIONS Aortic root replacement surgery reveals acceptable early mortality, low postoperative stroke rates, and acceptable long-term survival.
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Affiliation(s)
- Vikrant Dhurandhar
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; The Baird Institute, Sydney, NSW, Australia; Institute of Academic Surgery, The University of Sydney, Sydney, NSW, Australia.
| | - Roneil Parikh
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; The Baird Institute, Sydney, NSW, Australia; Institute of Academic Surgery, The University of Sydney, Sydney, NSW, Australia
| | - Akshat Saxena
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Institute of Academic Surgery, The University of Sydney, Sydney, NSW, Australia
| | - Michael P Vallely
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; The Baird Institute, Sydney, NSW, Australia; Institute of Academic Surgery, The University of Sydney, Sydney, NSW, Australia; Department of Cardiothoracic Surgery, Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia
| | - Michael K Wilson
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; The Baird Institute, Sydney, NSW, Australia; Institute of Academic Surgery, The University of Sydney, Sydney, NSW, Australia; Department of Cardiothoracic Surgery, Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia
| | - Deborah Ann Black
- Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Lavinia Tran
- CCRE Therapeutics, DEPM, Monash University, Melbourne, Vic, Australia
| | - Christopher M Reid
- CCRE Therapeutics, DEPM, Monash University, Melbourne, Vic, Australia; School of Public Health, Curtin University, Perth, WA, Australia
| | - Paul G Bannon
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; The Baird Institute, Sydney, NSW, Australia; Institute of Academic Surgery, The University of Sydney, Sydney, NSW, Australia
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Desai P, Parikh R, Deshpande R. 57. Total esophagectomy is not always necessary in the treatment of squamous carcinoma & adenocarcinoma of the distal third of the esophagus & the cardia. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.06.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Parikh R, Desai P. 311. Selection criteria for definitive chemo-radiotherapy (CT-RT) in low rectal cancers: A preliminary data from a single centre, India. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.06.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Dhurandhar V, Saxena A, Parikh R, Wilson M, Vallely M, Black DA, Tran L, Reid C, Bannon P. Mitral Regurgitation in the Elderly - Repair or Replace? A subset analysis of ischaemic and degenerative aetiologies from the ANZSCTS database. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2015.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Parikh R, Bannon P, Dhurandhar V, Virk S, Saxena A, Valelly M. The Prognostic Value of Elevated Troponin I for Short-term Mortality after Cardiac Surgery. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2015.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chadha M, Domi M, Parikh R, Kolev V, Koulos J. The time interval of adjuvant radiation therapy is influenced by the primary surgical technique used in treatment of endometrial cancer. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dhurandhar V, Parikh R, Saxena A, Vallely MP, Wilson MK, Black DA, Tran L, Reid C, Bannon PG. Early and Late Outcomes Following Valve Sparing Aortic Root Reconstruction: The ANZSCTS Database. Heart Lung Circ 2016; 25:505-11. [DOI: 10.1016/j.hlc.2015.10.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 09/20/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
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Parikh R, Wardle K. 47EMBEDDING MANAGEMENT AND LEADERSHIP INTO CLINICAL SUBJECT TEACHING: WHAT DO TRAINEES THINK? Age Ageing 2016. [DOI: 10.1093/ageing/afw029.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Parikh R, Wardle K. 46TRAINEES' PERCEPTIONS OF EXPERT PATIENT DEMENTIA TEACHING. Age Ageing 2016. [DOI: 10.1093/ageing/afw029.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wardle K, Parikh R. 44SHOULD WE INTEGRATE THE HUMANITIES INTO THE DELIVERY OF GERIATRIC MEDICINE? A SURVEY OF TRAINING PROGRAMME DIRECTORS. Age Ageing 2016. [DOI: 10.1093/ageing/afw029.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Dhurandhar V, Saxena A, Parikh R, Vallely MP, Wilson MK, Butcher JK, Black DA, Tran L, Reid CM, Bannon PG. Comparison of the Safety and Efficacy of On-Pump (ONCAB) versus Off-Pump (OPCAB) Coronary Artery Bypass Graft Surgery in the Elderly: A Review of the ANZSCTS Database. Heart Lung Circ 2015; 24:1225-32. [DOI: 10.1016/j.hlc.2015.04.162] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 03/24/2015] [Accepted: 04/04/2015] [Indexed: 11/29/2022]
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Dhurandhar V, Saxena A, Parikh R, Vallely MP, Wilson MK, Butcher JK, Black DA, Tran L, Reid CM, Bannon PG. Outcomes of On-Pump versus Off-Pump Coronary Artery Bypass Graft Surgery in the High Risk (AusSCORE > 5). Heart Lung Circ 2015; 24:1216-24. [DOI: 10.1016/j.hlc.2015.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 02/10/2015] [Accepted: 02/13/2015] [Indexed: 10/23/2022]
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Dhurandhar V, Parikh R, Vallely MP, Wilson MK, Black DA, Tran L, Reid C, Bannon PG. Early and late outcomes following valve sparing aortic root reconstruction: The ANZSCTS database. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2014.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Marathe SP, Vaideeswar P, Parikh R, Mishra P, Aironi B, Agrawal NB, Karunamurthy A. Noncompaction cardiomyopathy: Manifestation as a surgical pitfall – rare but real. Asian Cardiovasc Thorac Ann 2014; 23:133-9. [DOI: 10.1177/0218492314533559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Noncompaction cardiomyopathy is characterized by hyper-trabeculation of the myocardium. The patients present with heart failure and variable combination of arrhythmias and thromboembolism. Although several articles have shed light on the medical aspect of this disease, none have highlighted its surgical relevance. A death following ligation of a patent ductus arteriosus prompted us to evaluate the surgical aspects of this disease. Methods Autopsy records from 2003 to 2012 were reviewed, and cases identified as noncompaction cardiomyopathy were retrieved and analyzed. Cases with obligatory hyper-trabeculation were excluded. Results Thirteen patients were found to have noncompaction cardiomyopathy in 9427 autopsies performed. Their ages ranged from 4 months to 55 years; 10 were children, and all 3 adults were over 45 years of age. Only one patient had an antemortem diagnosis of noncompaction cardiomyopathy on echocardiography. There were 7 postoperative deaths. Conclusions Although noncompaction cardiomyopathy is rare, missing its diagnosis in a patient operated on for another indication can spell disaster postoperatively. As the clinical picture is nonspecific and the disease is not very well known, it needs vigilance on the part of the echocardiographer and surgeon.
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Affiliation(s)
- Supreet P Marathe
- PK Sen Department of Cardiovascular and Thoracic Surgery, Seth GS Medical College and KEM Hospital, Mumbai, India
| | | | | | - Prashant Mishra
- PK Sen Department of Cardiovascular and Thoracic Surgery, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Balaji Aironi
- PK Sen Department of Cardiovascular and Thoracic Surgery, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Nandkishor B Agrawal
- PK Sen Department of Cardiovascular and Thoracic Surgery, Seth GS Medical College and KEM Hospital, Mumbai, India
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Shah P, Swarnkar D, Parikh R. Development and characterization of microemulsion containing antihypertensive agent using factorial design. J Pharm Bioallied Sci 2012; 4:S69-70. [PMID: 23066212 PMCID: PMC3467821 DOI: 10.4103/0975-7406.94143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Microemulsion which act as a carrier for drug having poor water solubility, were formulated by the use of excipients having safety of administration and solubility of drug component. The phase study was carried out using isopropyl myristate, cremophor-el, propylene glycol and water with different ratios of components. Microemulsion region was chosen on basis of area covered. The % oil and % surfactant were selected as the independent factors and particle size and viscosity were selected as the dependent factors for the 2(2) Full Factorial Design. The optimized formulation showed the overcoming of the dissolution barrier helping in the formulation and administration.
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Affiliation(s)
- P Shah
- Department of Pharmaceutics and Pharmaceutical Technology, Ramanbhai Patel College of Pharmacy, Charotar University of Science and Technology, Changa, Ta: Petlad, Dist: Anand, Gujarat, India
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Mathur A, Parikh R, Kendall W, Leone J, Huang J, Pearson H, Bowers V. Pediatric En-bloc Kidney Transplant-a Small But Viable Answer to Augment the Donor Pool. J Surg Res 2012. [DOI: 10.1016/j.jss.2011.11.791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abstract
Waist circumference has been widely used as the parameter of central obesity in defining metabolic syndrome. Global consensus definition of metabolic syndrome has suggested various race- and gender-specific cutoffs of waist circumference for quantifying central obesity. We have earlier proposed that using index of central obesity (ICO), the need for race- and gender-specific cutoffs may be obviated. We propose that waist circumference be supplanted with index of central obesity in all definitions of metabolic syndrome. Using index of central obesity a common cutoff of 0.5 applicable across races and genders might be obtained. Moreover, it will enhance the sensitivity of definition by diagnosing subjects who are shorter than general population. Among 258 male and 242 female diabetic patients, subjects with metabolic syndrome (defined as per gender-specific waist circumference cutoffs), were found to have a common lower range of index of central obesity suggesting that a common cutoff of waist circumference may be obtained. In another study from National Health and Nutrition Examination Survey database, replacing index of central obesity with waist circumference was found to enhance the specificity and sensitivity of definition of metabolic syndrome.
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Casciano R, Wang X, Liu Z, Parikh R, Strosberg J, Riechelmann R. 6616 POSTER Impact of Progression on Resource Utilization in the Treatment of NET. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71927-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Casciano R, Wang X, Stern L, Liu Z, Parikh R, Riechelmann R, Cadiot G, Strosberg J. 6618 POSTER Cross-Sectional Analysis of Resource Utilization Among Patients With Neuroendocrine Tumours. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71929-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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